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Neuro Shelf > Neuro Drugs > Flashcards

Neuro Drugs Flashcards

1
Q

Vestibular neuronitis vs. labyrinthitis

A

Both are an inflammation in the inner ear

Vestibular neuronitis = continuuous vertigo w/o hearing loss

  • often after a URI
  • self-limited viral infection of the vestibular division of the vestibulocochlear nerve

Labyrinthitis = Combo of vestibular neuritis plus hearing symptoms
-often spread of infxn from the middle ear

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2
Q

3 ddx for restricted diffusion area on DWI scan

A
  1. infarct
    - failure of Na/K pump traps water in cells
  2. Abscess
    - water poorly diffuses thru pus
  3. Hypercellular tumors
    - primary CNS lymphomas
    - medulloblastoma (children)
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3
Q

COMT inhibitors

A

COMT inhibitors block the enzyme that breaks down excess dopamine at the presynaptic neuron => increases half life of sinemet

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4
Q

What is the caloric reflex testing?

(a) Normal response?

A

Caloric reflex testing: to test the vestibular-ocular reflex

(a) Normal response: COWS = cold-opposite, warm-same
- cold water causes fast beat of nystagmus to the side opposite the ear where cold water is entered
- warm water causes fast beat of nystagmus to the same side of the ear where warm water is placed

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5
Q

35 yo M develops sudden twisting of neck and protruding tongue after presenting to the ER w/ terrible nausea 2/2 migraine

(a) What med was he given?
(b) Tx

A

(a) Metoclopramide/Reglan
- antiemetics can cause drug-induced Parkinsonism

(b) Tx - diphenhydramine (benadryl)

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6
Q

Guanfacine

(a) Mechanism
(b) Major indications

A

Guanfacine (Tenex)

(a) Selective alpha-2A agonist = sympatholytic
(b) ADHD, tics, GAD, HTN

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7
Q

Essential tremor

(a) Symptoms commonly alleviated by what?
(b) First line tx

A

Essential tremor

(a) Often alleviated by EtOH

(b) First line tx = non-selective beta-blocker = Propranolol
- selective (like atenolol) not as effective b/c beta-1 effects predominate

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8
Q

Function of the vestibular-ocular reflex

A

VOR = keep eyes fixated on object when head is moved rapidly

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9
Q

Tx for orthostatic hypotension in Parkinson’s pt

A

Tx w/ fludrocortisone = synthetic corticosteroid w/ moderate glucocorticoid but very potent mineralocorticoid effect

=> acts like aldo to cause salt (and therefore water) retention

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10
Q

What does a positive Romberg’s test indicate?

A

Positive Romberg’s = pt steady when eyes are open, but loses balances when closes eyes, indicates instability of the proprioceptive system

Indicates vestibulopathy (injury to the vestibular system)

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11
Q

Most common culprits of drug-induced Parkinson’s

A

Typical antipsychotics and anti-emetics (reglan)

Also CCB

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12
Q

Pt on triptans as abortive med for migraine w/ aura wants contraception, best advice?

A

Estrogen-containing contraception (combined OCPs) contraindicated in ppl w/ migraine w/ aura b/c f the increased stroke risk

So:

  • mini pill (progesterone only)
  • IUD
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13
Q

Tx of Tourette’s

(a) First line
(b) Second line

A

Tourette’s

(a) First line = guanfacine (Tenex) = sympatholytic = selective alpha-2A agonist
(b) Can also use haldol/risperdal

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14
Q

Name some central causes of vertigo

A

Central causes of vertigo

  • ischemic and hemorrhage stroke
  • MS
  • vertebral artery dissection
  • migraine
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15
Q

Natalizumab (Tysabri)

(a) Mechanism
(b) Side effects

A

Natalizumab (Tysabri)

(a) Interferes w/ receptor to reduce transmission of immune cells into the CNS
(b) Major concern = risk of PML

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16
Q

(a) First line tx for restless leg syndrome

(b) What can RLS be a predecessor of?

A

(a) Dopamine agonists
ex: roperinole

(b) Often precedes more serious illness like Parkinson’s

17
Q

Tx for spastic torticollis

A

Tx = botulinum toxin

18
Q

Define vertigo

(a) Symptoms of acute vertigo syndrome

A

Vertigo = abnormal sensation of movement due to asymmetric neural activity from the right and left vestibular systems

(b) N/V, nystagus, postural instability

19
Q

Central causes of vertigo associated w/

(a) multiple prodromal episodes of dizziness
(b) HA and neck pain
(c) Truncal ataxia and gait instability

A

Central causes of vertigo (obv more concerning than peripheral)

(a) TIA
(b) HA, neck pain, vertigo- c/f vertebral artery dissection
(c) Cerebellar infarct

20
Q

Contraindication to sumatriptan use as abortive med for migraine HA

A

Coronary artery disease b/c triptans have vasoconstrictive properties and therefore carry risk of stroke

21
Q

Pt on haloperidol develops fever and rigidity

Tx?

A

Tx = dopamine agonists = Bromocriptine

22
Q

(a) When are meds for migraine ppx indicated?

(b) Meds for migraine ppx

A

(a) Meds indicated when pt has 2 or more migraines in a month, also if the migraines disrupt school/work

(b) Most common = Topiramate (AED)
Can also use: AED (Depakote), TCAs (amitriptiline), beta-blocker (propranolol), riboflavin (B2), and CCB

23
Q

Differentiate central and peripheral nystagmus

(a) Direction
(b) Effect of change in direction
(c) Effect of visual fixation
(d) Presence of brainstem symptoms or hearing loss
(e) Direction of truncal instability
(f) Severity of symptoms

A

Central nystagmus (CNS pathology)

(a) Vertical or rotary
(b) May change w/ direction of gaze
(c) Symptoms unchanged by visual fixation (staring at something)
(d) May be presence of brainstem symptoms (diplopia, weakness, numbness, ataxia) but no hearing loss
(e) Pt falls towards the side of the lesion
(f) Mild vertigo

Peripheral nystagmus

(a) Usually horizontal, occasionally rotary (but not vertical)
(b) Unidirectional and conjugate = same direction and same in both eyes
(c) Decreased nystagmus (and vertigo) w/ visual fixation in peripheral
(d) No brainstem/neurologic findings, may be hearing loss
(e) Pt falls away from the lesion
(f) Severe vertigo, prominent N/V

24
Q

First line for tx of chorea in Huntington’s

A

High potency typical antipsychotic, usually Haloperidol

25
Q

Cluster headaches

(a) Abortive tx
(b) Ppx meds

A

(a) 100% oxygen
- not IV triptan or morphine

(b) Ppx: CCB (Verapamil), steroids, and Lithium

26
Q

Meniere’s disease

(a) Physiology of disease
(b) Associated symptoms
(c) Tx

A

Meniere’s disease

(a) rupture of membranous labrynth that causes distention of the endolymph and death of hair cells in the cochlea
(b) Vertigo, sensorineural hearing loss, tinnitus (ringing in ears), feeling of fullness in ears
(c) Tx = low-salt diet and diuretics (essentially want to decrease fluid in the ear
- surgical drainage in refractory cases

27
Q

Bromocriptine

A

Dopmaine agonist

28
Q

First line tx for trigeminal neuralgia

(a) Monitoring necessary

A

Carbamzepine (tegretol) = AED
-stabilizes inactivated state of voltage-gated Na channels

(a) Monitor Na+ (BMP) b/c can cause hypotnatremia

29
Q

Side effects of Sinemet: immediate vs. later

A

Immediate side effects (w/in days of starting drug): somnolence, confusion, hallucinations (esp in elderly)

While later (like years later): dyskinesias/involuntary mov’ts

30
Q

46 yo F started on haloperidol paces the hallway and constantly adjusts legs while sitting

(a) Dx
(b) First line tx

A

(a) Akathisia = motor restlessness, common side effect of typical antipsychotics
(b) First line tx = propranolol = non-selective beta-blocker

31
Q

Differentiate the clinical presentation of lateral vs. medial cerebellar injury

A

Lateral cerebellar injury = ataxia of ipsilateral arm/legs (lateral symptoms)

Medial cerebellar injury = gait ataxia and imbalance (more medial findings)

32
Q

BPPV

(a) Physiology of disease
(b) Type and direction of nystagmus
(c) Characteristic symptoms

A

Benign Paroxysmal Positional Vertigo

(a) Displacement of calcium carbonate crystals (otolyths) from saccule/utricle into one of the semicircular canals
(b) Rotational nystagmus towards the affected ear
(c) Brief intense episodes of vertigo triggered by certain head movements/positions

33
Q

Explain why carbidopa is added to levadopa

A

Don’t give pure dopamine b/c it doesn’t cross the BBB

Carbidopa doesn’t cross BBB either, so it prevents conversion of levadopa to dopamine outside the CNS to prevent emesis, while allowing more levadopa to be available in the CNS for replacement

34
Q

Essential tremor

(a) Differentiate from Parkinson’s
(b) Findings on EMG

A

Essential tremor

(a) Action (not resting) tremor, more likely to be b/l
(b) EMG: 3Hz, irregular tremor

35
Q

Lateral Medullary Syndrome = Wallenberg’s

(a) Cause
(b) Cerebellar symptoms
(c) Sensory findings
(d) 3rd feature

A

Wallenberg’s

(a) Due to vertebral artery or posterior inferior cerebellar artery occlusion
(b) Cerebellar symptoms: dysphagia, hoarseness, nystagmus, N/V, gait and balance issues
(c) Contralateral loss of pain/temp in the body with ipsilateral loss of pain/temp in the face
(d) Horner’s syndrome: miosis, ptosis, anhidrosis

36
Q

Requip

(a) Indication
(b) Contraindication
(c) Caution

A

(a) Requip/Ropinirole = dopamine receptor agonist used in early tx of Parkinson’s pts
(b) Contraindicated in elderly 2/2 psychiatric symptoms
(c) Caution- can cause impulsive behavior like gambling addition or hypersexuality

37
Q

What are otoliths?

(a) Location
(b) Role in BPPV

A

(a) Otoliths = calcium carbonate cystals in the utricle and saccule of the inner ear
(b) Displacement of otoliths from the utricle/saccule into one of the semicircular canals (usually the posterior) is the mechanism of disease in BPPV

38
Q

Adverse effect of Sinemet

A

Dyskinesias

39
Q

MS drugs

(a) Downsides to Avonex
(b) Efficacy of injectibles

A

MS drugs

(a) Avonex = interferon beta
- injectible
- flu-like symptoms that are often intolerable

(b) Injectibles reduce relapses by about 33% (1/3) w/ very few serious safety concerns

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